Today surrogacy is in the news more frequently than ever before - it seems that barely a month goes by that a celebrity is showing off their new bundle of joy – a baby born through surrogacy. But surrogacy isn’t limited to celebrity circles, it’s a viable solution for women who suffer from physical issues that affect their ability to safely carry a baby to term.

When it comes to the actual facts of the surrogacy process, how much do you know?

Whether you’re considering surrogacy as the next step in your own infertility treatment, or you’ve known for years that you would need the help of a surrogate mother to build your family, or even if you’re just supporting a loved one through the surrogacy process, here are some key questions and concerns that have probably crossed your mind, as well as answers to reassure you.

1. Will the surrogate mother have a genetic link to my child? Most surrogacy arrangements today are gestational, not traditional. What’s the difference? You may remember the early days of surrogacy from the news, when it wasn’t uncommon to hear about disputes over parental rights to babies born via surrogacy (the “Baby M” case in New Jersey being one of the most widely publicized). These childbearing arrangements were called “traditional surrogacy,” where the woman who acts as the surrogate mother uses her own egg to achieve a pregnancy, thereby establishing a genetic link to the child she bears for the couple. Though some traditional surrogacy arrangements are still carried out today, they are uncommon. Instead, most fertility centers and surrogacy agencies promote gestational surrogacy, where the embryo is created such that the surrogate mother has no genetic connection to the baby she carries for the infertile couple (known as the “intended parents”). In surrogacy today, the egg is supplied by the intended mother whenever possible. But in cases where the intended mother cannot provide eggs for the in-vitro fertilization cycle, an egg donor is used. Regardless of the source of the eggs used to create embryos though IVF, the gestational carrier only grows and delivers the baby – she has no genetic connection to the child she bears for her intended parents.

2. Is a surrogate mother’s main motivation the fee she receives for carrying a baby?

The vast majority of women who become surrogate mothers are not motivated by the money they earn from it. On the surface, it might seem that surrogate mothers earn a great deal of money for only nine months of work. But the reality is that even under the most ideal conditions, a surrogacy arrangement takes a minimum of 12 months from the time a couple agrees to work with a woman as a gestational carrier through the birth of the child, and that doesn’t even include post-partum recovery time. And 12 months is a best-case scenario – many times a surrogacy arrangement may take 18-24 months or more to complete due to medical or legal obstacles along the way.During the pregnancy, the surrogate mother is responsible 24 hours a day for the health and safety of the baby she’s carrying, so if you compute the fee she’s being paid into an hourly rate, it’s only a fraction of minimum wage. In addition, surrogates who are matched through surrogacy agencies are subject to a screening and background check process that includes ensuring that she’s not using any form of public assistance and is financially stable (intended parents seeking an independent match with a surrogate – that is, finding a surrogate mother on their own, without an agency – would need to ascertain these things for themselves).

While the fee that surrogates earn for carrying and delivering a baby for someone else is appreciated, most surrogates are much more motivated by being able to help another woman become a mother or help an infertile couple become a family. And by and large, surrogates truly enjoy the experience of pregnancy and birth and are pleased to go through both again for someone else, without expanding their own families.

3. Will the surrogate mother have a hard time letting go of the baby she carried?

A healthy and emotionally stable surrogate does not want to keep your baby. Most women who decide to become surrogate mothers view the pregnancy as a chance to grow and nurture someone else’s baby. While the pregnancy is theirs to experience, they see a separation between the pregnancy and the child they’re carrying – a child who belongs to someone else. This distinction is very clear to them from the outset, long before they’re ever pregnant. Surrogate mothers are motivated by the joy they get from helping an infertile couple, not because they want another baby for themselves. It’s often said that surrogates look forward to labor and delivery so they can return the baby to its rightful place – its parents’ arms.Most surrogacy agencies and fertility centers have a mental health protocol they follow for surrogacy arrangements, which includes psychiatric evaluation and facilitated conversations between a potential surrogate mother and the couple she’s carrying for. Part of this evaluation explores this issue in depth to ensure that the surrogate is mentally stable and healthy and has a thorough understanding of the physical as well as emotional demands of surrogacy.

4. How do I know that a woman is qualified to be a surrogate mother?

Surrogate mothers have to pass rigorous physical and mental health screenings.The minimum requirement for a woman to serve as a surrogate mother is that she must have successfully completed at least one pregnancy and delivery. Beyond that, surrogacy agencies and fertility centers have their own range of criteria that they screen for. Some of these factors include age, weight, blood pressure, current and past medical conditions, sexually transmitted and blood-borne diseases, number of prior pregnancies and deliveries, pregnancy outcomes, etc.

Once a woman has passed the preliminary medical screening, she may have additional tests performed that assess her uterus, fallopian tubes, and hormone levels to determine if she’s a good candidate for the demands of a surrogate pregnancy. She will also be evaluated by a mental health professional as an individual and in conjunction with her prospective intended parents.

5. Is it hard to find someone to serve as a surrogate mother?

It’s not terribly hard to find a surrogate mother. It is, however, important to find the right match in a surrogate mother.Couples who need a surrogate mother to carry for them generally find them in one of three ways:

They ask someone they know to carry for them, or a friend or family member offers,

They pay a surrogacy agency to find a match for them, or

They search independently (usually online) for a woman to be their surrogate mother.

There are several online sites that couples and potential surrogates use to connect with one another, and these are considered “independent” arrangements (i.e., no agency is involved). Couples or surrogates who decide to make independent arrangements must bear the full responsibility of checking and verifying each other’s backgrounds and intentions and thoroughly explore whether or not they are a good match for each another.

By using an agency that specializes in finding surrogate mothers, a couple pays a fee to be matched with a woman who has been pre-screened and shares compatible views on pregnancy, birth and surrogacy in general. There are no guarantees that a match made through an agency will end up being a great experience for all parties concerned, but it can be a more efficient way for like-minded intended parents and potential surrogate mothers to find each other. In addition to basic compatibility between the intended parents and the surrogate mother, it’s important that everyone has enough time to develop a good sense of each other and build a degree of trust. Should problems arise during the surrogacy, an agency can step in and help resolve problems, while there is no one in the mediator role in an independent surrogacy arrangement, which is an important element to consider.

Surrogacy is a life changing experience for all parties involved. For infertile couples, surrogate mothers are a much-needed piece in solving their infertility puzzle. For surrogates, the chance to have such a positive effect on someone’s life is uniquely and profoundly fulfilling and unmatched by most anything else. For all parties, though, the most critical factor to success is going into the experience fully informed and taking the process at a pace that allows everyone to feel comfortable creating a miracle together.